Abstract
Worldwide medical literature supports the notion that environmental and nutritional factors play a role in the development of cancer. Nutritional recommendations to the public to help prevent cancer are available from the US's National Cancer Institute, the American Cancer Society, and other organizations. However, when it comes to treating patients who have been diagnosed with cancer, the vast majority of oncologists fail to deal with nutritional and lifestyle factors to help their patients manage their cancers. Evidence continues to mount that some of the same recommendations designed to prevent cancer should also be applied to patients who already have cancer.
Implementing such a program of lifestyle modifications, improvement in diet, exercise, stress management, optimal exposure to sunlight, improving energy flow, and nutritional supplements should improve cancer patients' survival statistics and the quality of life of these patients, including significantly reducing the side effects of conventional treatments.

This article focuses on dietary changes and nutritional supplements to help clinicians educate cancer patients, so that they may better deal with their illness. Highlighted are: principles involving an optimal diet, avoidance of harmful chemicals and use of nutritional supplements. Some of the controversies surrounding nutritional supplements are reviewed. Specific topics covered include: a broad range supplement program, vitamin C, amygdalin, iodine, fermented wheat germ extract, mushroom extracts, supplements developed by the late Mirko Beljanski, PhD, and the antineoplastons of Stanislaw Burzynski, MD, PhD.

Finally, there is a discussion about paradigms in health care and the effects of politics and economics on how health care is practiced today.

Determining Total Body Iodine Sufficiency: The Iodine Loading Test
In his excellent short book on iodine, Brownstein summarizes his own clinical experience with hundreds of patients for whom he has prescribed iodine with excellent results and minimal side effects. To determine whether a patient is iodine sufficient, he uses the iodine-loading test described by Abraham and now in use at the Schachter Center. This was the test that Abraham used to determine if a person had an optimal amount of iodine in his/her body. Other research had shown that iodine is readily absorbed when ingested orally and readily excreted in the urine. The assumption was that if a person ingests a given amount of iodine and is iodine sufficient, most of the iodine should be found in the urine over a 24-hour period. On the other hand, if the person does not have an optimal amount of iodine in his body, when he ingests the iodine, his body will tend to hold onto it and a smaller amount will be found in the urine during the 24-hour collection period.46

To do this test, a patient first empties his bladder and then ingests 50 mg of iodine/iodide. The patient then collects his urine for the next 24 hours and sends a sample of it along with a note that includes the total volume collected is sent to an appropriate laboratory. If the person excretes 90% or 45 mg of the iodine, he is considered iodine sufficient. If less is excreted, the patient is not optimally sufficient or is iodine insufficient and a therapeutic dosage of iodine may be administered for a period of time and then the test is repeated. Brownstein has found in using this test that more than 90% of his patients are iodine insufficient. Once a person is iodine sufficient, the maintenance dose for an adult to maintain sufficiency is about 12.5 mg of iodine/iodide daily. The treatment dose when a person is iodine insufficient is generally be-tween 12.5 mg and 50 mg daily. Preliminary research indicates that if a person is iodine insufficient, it takes about 3 months to become iodine sufficient while ingesting a dosage of 50 mg of iodine and a year to become iodine sufficient while ingesting a dosage of 12.5 mg of iodine daily. However, the patient needs to be monitored closely with awareness of possible side effects and detoxification reactions. Cancer patients taking 50 to 100 mg of iodine daily may take more than a year to achieve iodine sufficiency as defined by this test.

The dosage of about 12.5 mg of iodine daily can be obtained with 2 drops of Lugol's solution or from an identical over-the-counter solution. This same dosage is also available in an over-the-counter tablet or capsule. Each capsule or tablet or 2 drops of the Lugol's solution contains 5 mg of the reduced elemental form of iodine (preferred by the breast, ovary, and prostate) and 7.5 mg in the iodide form (preferred by the thyroid gland). Numerous testimonials indicate that many patients improve a variety of symptoms with optimal supplementation of this supplement.

Detoxification Effects of Iodine and Protocol for Avoiding Adverse Effects
This dose of iodine may have other benefits as well. Abraham has shown in his work that iodine promotes the excretion of toxic minerals, such as lead, mercury, and cadmium, as well as the toxic halogens fluoride and bromide. In the May 2005 edition of Nutrition and Healing, Jonathan V. Wright, MD, notes that his laboratory has also shown that iodine helps remove toxic elements, including bromide and fluoride, from the body. With this mobilization of toxic elements, patients may develop temporary side effects such as fatigue, irritability, palpitations, or anxiety that can be reduced by lowering the dosage of iodine and making sure that other aspects of nutrition and nutritional supplementation are in place.

Brownstein suggests a protocol that we are currently using when iodine is recommended. The protocol includes: checking your body weight in pounds and drinking at least one-half your body weight in ounces of pure water every day (juices, tea, and other beverages do not count); 1 to 2 tspf of unrefined salt daily (¼ teaspoonful of unrefined salt can be added to a quart of water; blood pressure should be monitored for the occasional person who is very salt-sensitive), daily doses of 200 to 400 mcg of selenium, 3 to 6 grams of vitamin C in divided dosage, and 300 to 1200 mg of an absorbable form of magnesium (like magnesium glycinate). Side effects or intolerances to the quantities of these supplements, such as diarrhea or frequent bowel movements to vitamin C or magnesium, need to be checked and dosages adjusted as necessary. All of these should be in divided dosage of about 3 times daily. This helps to reduce toxic side effects of bromine mobilization from tissues when iodine is supplemented. A physician knowledgeable about iodine who can order appropriate tests when necessary should monitor this procedure.

The Possible Role of Iodine in Preventing and Treating Cancer: Counteracting Carcinogenic Agents (such as Bromine and Fluoride) while Promoting the Formation of Iodinated Lipids
Iodine's role in helping to prevent and treat cancer needs much more exploration and research, but there is suggestive evidence that it plays a role in preventing and/or treating cancer (especially involving the thyroid gland, breasts, prostate, ovaries and uterus). As mentioned previously, Max Gerson, MD, whose successful alternative therapy involved using fresh vegetable juices and intensive detoxification, recommended Lugol's solution for all of his cancer patients. Numerous rat studies by Eskin show a direct relationship between iodine deficiency and breast abnormalities including cystic mastopathy and breast cancer.61-63 According to Brownstein, when Eskin applied to the NIH for grants to do studies on humans, he was refused funding because of the Wolf-Chaikoff Effect.

Iodine deficiency predisposes to breast cancer, and high fat diet predisposes to iodine deficiency.64 Japan and Iceland have high iodine intake and low goiter and breast cancer rates; just the reverse occurs in Mexico and Thailand.65 Iodine protects against estrogenic effects in breast cancer.66,67 Thyroid hormone therapy contributes to breast cancer in iodine-deficient women.68 Female rats require 20 to 40 times the amount of iodine needed to control breast cancer and fibrocystic disease than to prevent goiter.69 When iodine was used in dough during the 1960s, one slice of bread a day contained the Recommended Daily Allowance (RDA) of 150 mcg. The average iodine intake was >700 mcg daily and the breast cancer risk was 1:20. With the replacement of iodine in bread dough by the goitrogen bromine in the early 1980s, the average iodine intake was reduced below the RDA of 150 mcg and the rate of breast cancer increased to 1:8 (absorption of iodine from bread is much better than from iodized salt). This seems to me to be a totally unrecognized correlation that may be causal in nature. It wouldn't be the first time that a disastrous public health decision was made. As a result of exposure to goitrogens, including the addition of bromine to all baked goods, the amount of iodine needed to counteract the effects of these goitrogens has drastically increased. This is one of the main reasons that the average person needs so much iodine for optimal functioning. One researcher commented that to overcome the effects of goitrogens in the food chain such as bromine in dough, daily amounts of iodine ingested in Japan would be necessary (referring to the 13 mg daily in Japan).70

Brownstein in his previously mentioned book describes three cases of breast cancer that did remarkably well with an intake of iodine in the 50 mg range. A 63-year-old female English teacher, diagnosed with breast cancer in 1989, declined conventional treatment and took 50 mg per day of Iodoral (iodine). Six weeks later, a PET scan showed "all of the existing tumors were disintegrating." A 73-year-old diagnosed in 2003, declined conventional treatment and took 50 mg of Iodoral daily. An ultrasound of the breast 18 months later showed reduction in size of the tumor. Two years later, there was no evidence of cancer. A 52-year-old woman with breast cancer and no conventional treatment was given 50 mg per day of iodine. Three years later, mammograms and ultrasound exams showed decreasing size of the tumor with no progression.

At higher doses in the range of 50 mg daily, iodine combines with lipids to form iodinated lipids such as delta-iodolactone, which causes apoptosis in cancer cells. RDA levels (microgram doses) do not do this. Recent work shows strong anticancer activity in breast cancer cells.71 Research in this area is beginning to pick up worldwide.

A website with more information about the relationship between insufficient iodine and breast cancer is www.breastcancerchoices.org. Given all of this information about breast cancer and some epidemiologic evidence relating to higher incidence of prostate and thyroid cancer in iodine insufficient areas, it seems reasonable to consider that suboptimal iodine levels may play a role in many if not all cancers, and that Gerson was correct in giving all of his cancer patients iodine as Lugol's solution.

Countering Goitrogens with Iodine and Iodine as an Anti-Infectious Agent: Uses to Purify Water and for Swimming Pools and Spas
Iodine insufficiency problems are aggravated by our use of agents that interfere with the utilization of iodine (sometimes called goitrogens because they may cause an enlargement of the thyroid gland). These include the halogens (class of chemicals to which iodine belongs) fluoride, bromine and bromides and chlorine. Fluoride is added to 50% of the US water supplies, is present in most toothpaste, and is used in dental treatments for children. It is also present in many processed foods and beverages. Fluoride can interfere with iodine utilization. Critics of fluoridation and use of other fluoride products believe that fluoride is carcinogenic and has many other side effects. In the case of fluoride, we have also been sold a bill of goods based largely on economic motivations. In the 1940s, due to deaths of livestock from fluoride emanating from industrial plants such as aluminum and fertilizer factories, the AMA and ADA considered fluoride to be an environmental pollutant, which it is. As a result of a massive public relations campaign and some very weak science, fluoride became an essential nutrient that protects against dental decay. It was added to the water supply, used by dentists to treat the teeth, used in fluoridated toothpaste, and given to babies to prevent dental decay. Aside from causing dental fluorosis (ugly white spots on the teeth) in many children, fluoride became another risk factor for many degenerative diseases, including cancer. Did the public health system under the influence of corporate dollars make a mistake? In my opinion, it did, but the predominant conventional view is still that fluoride is harmless and beneficial the way it is used. As mentioned previously, I advise all of my patients to avoid fluoride as much as possible. Possible mechanisms for damaging effects of fluoride must include its interference with the proper utilization of iodine.

Bromine replaced iodine in most baked goods in the 1980s because of the concern that iodine might be toxic. In fact, it is the bromine that is toxic. Bromine interferes with iodine utilization. Bromine is also used to disinfect hot tubs and is present in many medications, including asthma medications. It is also currently present in certain soft drinks such as Mountain Dew and certain Gatorades. Bromine is present in many pesticides and herbicides, fabrics, the interior of new cars, electronic equipment, and many other common products.

Chlorine, used to treat swimming pools and present in many of the public drinking water supplies, also interferes with iodine levels in the body. Safer water purification systems, like ozone and iodine itself, exist but are currently not widely used.

The use of iodine to prevent infections in drinking water supplies and in swimming pools is far superior and less expensive than the use of chlorine or bromine with concentrations of iodine at 1 to 2 ppm.45,72-75 In these studies, iodinated drinking water was found to be safe and tasty. Competitive swimmers consistently found that pools cleansed with iodine as compared with chlorine were less irritating and preferred the iodinated swimming pool water. The advantage of using iodine for these purposes is that it would help people get the essential nutrient that they need while at the same time cleansing the water effectively. However, the pervasive fear of iodine by the health-care industry and governmental agencies has not allowed this to happen. One reason that swimming pools may need something in addition to iodine is that the iodine at this concentration does not get rid of algae. Consequently, chlorine shocking may still be necessary occasionally.

Sources of Iodine: Problems with Iodized Salt
Most people get iodine in their diet from seafood and iodized salt. However, only about 50% of Americans use iodized salt, in part no doubt because of concerns about high blood pressure that have resulted in many people's reducing their salt intake. One gram of salt contains 77 mcg of iodine. The iodine present in iodized table salt is poorly absorbed; one study indicated that only about 10% is actually absorbed.76 In contrast, the iodine absorbed from baked goods when iodine was used as a dough conditioner is about 90%. The RDA of iodine is 150 mcg (somewhat higher for pregnant women and certain other groups). Though 150 mcg daily may be sufficient to prevent an enlarged thyroid (goiter) and cretinism (severe iodine deficiency in babies leading to mental retardation and impaired development), these values are far short of the optimal values of 12,500 mcg (12.5 mg) recommended by Abraham. But, even using the lower values, many people still do not get the RDA, and tests have shown that the average blood levels of iodine have decreased significantly over the past 30 years, in part no doubt due to the substitution of bromide for iodide in baked goods in the early 1980s. According to the last national nutritional survey (NHANES III 1988-1994), 15% of the US adult female population has moderate to severe iodine deficiency as defined by the World Health Organization: levels of iodine/iodide below 50 mcg/L, present in a random urine specimen. Therefore, 1 in 7 women in the US are frankly iodine deficient.77

International Iodine Problems
Worldwide, the soil in large geographic areas is deficient in iodine. Twenty-nine percent of the world's population, living in approximately 130 countries, is estimated to live in areas of deficiency. WHO claims that iodine deficiency is the world's greatest single cause of preventable mental retardation. Iodine is the most deficient trace mineral in the world. 3 of all peoples are deficient.78 Iodine deficiency is the number one cause of underfunctioning intellect.79 The best way to cripple a nation is to make the people iodine deficient. Mild iodine deficiency is defined as levels between 50 and 100 mcg/L found in a random urine sample. Moderate deficiency occurs at iodine levels between 20 and 50 mcg/L. Severe deficiency is defined as a level below 20 mcg/L. The relationship between various levels of iodine deficiency and the prevalence of goiter, likelihood of elevated TSH (low thyroid), and presence of cretinism are shown in Table 5. Goiter and elevated TSH drastically increase as the iodine level in the urine is reduced. In spite of this clear problem of iodine deficiency using even the WHO criteria, physicians in the US never order urinary iodine levels or serum iodine levels, even though the tests are available from commercial laboratories. In my 40 years of practicing medicine, I never ordered an iodine test and never heard of any physician who did. It is only after learning about iodine issues from Abraham's papers that I began to order the tests.

The concentration of iodine in urine of people who are not supplemented with the higher doses of iodine discussed previously (12.5 to 50 mg daily) is two orders of magnitude less than that found in the urine of supplemented patients (5 to 10 or more mg/L of iodine). The concentration of iodine in serum is also two orders of magnitude higher when patients are supplementing with the milligram doses of iodine, and at these levels patients appear to not exhibit evidence of toxicity unless they are mobilizing bromine or other toxic substances.

All things considered, I think that the therapeutic use of iodine/iodide has the potential of drastically changing how medicine is practiced today, including the prevention and treatment of cancer. All of Dr. Guy Abraham's research papers relating to the Iodine Project may be viewed and downloaded free from the Internet by accessing www.optimox.com and clicking on "Iodine Research."

Fermented Wheat Germ Extract for Cancer Patients
A nutritional supplement that has been well researched for cancer patients is a fermented wheat germ extract developed in Hungary by Maté Hidvegi, PhD, based on research initiated many years ago by Dr. Albert Szent-Györgyi, a recipient of the Nobel Prize in Medicine. Szent-Györgyi theorized that naturally occurring compounds called quinones would suppress anaerobic metabolism in cancer cells and enhance oxidative metabolism in normal cells. This is what the fermented wheat germ product Avemar does. However, it also appears to have several other mechanisms of action to help control the cancer process. These include immune modulation, apoptosis induction, antiangiogenesis activity, antimetastatic activity, and inhibition of cancerous DNA synthesis.

Avemar is produced by a patented process involving a fermented wheat germ extract that yields a uniform, consistent, all-natural dietary supplement. More than 100 reports have been written for presentation or publication describing research conducted in the US, Hungary, Russia, Austria, Israel, and Italy. Its value has been validated by the publication of more than 18 peer-reviewed studies accessible on Medline. Clinical studies have shown that when Avemar is added to a program of conventional treatment for at least a year, long-term follow-up shows reduced progression of cancer, reduction of metastases, and improved survival in a variety of cancers, including primary colorectal cancer, malignant melanoma, and head and neck cancers.80-82 It also significantly reduces side effects from conventional treatment and improves the quality of life of patients using it. It appears to be very safe and there are no reported significant side effects in any of the studies. Avemar research can be found via the websites of the National Library of Medicine (www.pubmed.gov) and/or the American Society of Clinical Oncology (www.asco.org) with the search terms "Avemar" or "fermented wheat germ." The full text of most studies can be found through the website www.avemarresearch.com. Additional information is available at Dr. Hidvegi's website, www.matehidvegi.com.

Mushroom Extracts
Background
A mushroom is the fruiting body of a fungus, which, unlike plants, does not contain chlorophyll. Fungi are not classified as part of the plant or animal kingdom, but constitute their own kingdom. Their function appears to be to help recycle dead and dying matter. They help to decompose dead trees, plants, and animals to form nutrients necessary for the growth of new plants and animals.

For centuries, it has been known that some mushrooms have the potential to make people sick or even kill them, while others have beneficial and healing effects. Mushrooms or mushroom extracts have been used in traditional medicine to enhance healing for hundreds of years. Two little booklets that nicely describe types of healing mushrooms with their therapeutic effects are by Lisa Alschuler, ND, and Mark Stengler, ND.83,84 Each booklet is extensively referenced. Mushrooms that have been used therapeutically include Agaricus bisporus (white button), Agaricus blazei (sun mushroom), Cordyceps sinensis (caterpillar mushroom), Coriolus versicolor, also known as Trametes versicolor (turkey tail), Hericium erinaceus (lion's mane), Maitake (dancing mushroom), reishi, shiitake, and Tremelia fuciformins (silver ear or white jerry leaf).28 Medicinal mushrooms have been integrated into the treatment of cancer patients, and several of them have reported benefits in enhancing immune function, reducing side effects from conventional treatment, and improving overall therapeutic results. The main medicinal mushrooms used as part of a cancer treatment program are Agaricus, Maitake D-Fraction, lentinan from shiitake, PSK and PSP from Coriolus versicolor, reishi extract, and Phellinus linteus.

Extracts from Coriolus have been developed in both Japan (known as PSK) and China (PSP). They are slightly different, but both contain beta-glucans, a type of polysaccharide. These compounds are often prescribed in Japan and China as adjunctive treatment for cancer to stimulate immune support after surgery and/or during or after radiation and/or chemotherapy. In one 10-year study in Japan involving non-small cell carcinoma of the lung, the 5-year survival rate for stage I and II was 39% compared with 16% in patients not receiving PSK. For stage III lung cancers, 5-year survival for the PSK group was 22% compared with only 5% in the group not receiving PSK.85 Another study, which was a randomized, double-blind placebo-controlled 10- year study that looked at the effects of PSK vs. a placebo after colon-cancer surgery, clearly showed a statistically significant effect of improved survival for the PSK group.86

Maitake D-Fraction for Cancer
A good deal of work has been done with Maitake D-Fraction, and I have introduced this supplement into my practice for cancer patients. Sensuke Konno, PhD, of the Department of Urology at New York Medical College in Valhalla, New York, has been carrying out some interesting studies on Maitake D and has published several articles.33,34,87 His focus has been on the in vitro cytotoxic effects of Maitake D on prostate and bladder cancer cells. In Figure 3, one can see how various concentrations of Maitake D can inhibit prostate cancer cell viability. (Note that PDF = Maitake D fraction in these studies.) At 500 mcg/ml, there is almost a 20% inhibition of cancer cell viability, while at 1000 mcg/ml there is almost 40%.

Figure 3

Using this same model, Figure 4 shows us the cell viability potential of vitamin C. Note that it takes a concentration of 300 micromoles to begin inhibiting the prostate cancer cells, with the most inhibition coming from 1000 micromoles. In vivo, it is difficult to reach these levels.

Figure 4

But when Maitake D and vitamin C are combined as shown in Figure 5, there is a synergistic effect with much lower doses of C and Maitake D being able to inhibit the cancer cells.

Figure 5

An inhibitory effect of 90% is obtained with concentrations of C (only 200 micromoles) and Maitake D (150 mcg/ml), which are much lower concentrations than the doses needed to get inhibition when the two substances are used separately. So there is clearly a synergistic effect. These levels can be reached with oral doses of about 500 mg of vitamin C and 25 to 50 mg of Maitake D taken orally. The mechanism for this inhibition appears to be apoptosis, as shown in Figure 6.88 Konno has also shown a similar synergistic effect between Interferon Alpha 2B and Maitake D-Fraction on these prostate cancer cells.

Figure 6

Previously, Konno had shown the identical phenomenon of a synergistic effect of Maitake D-Fraction and vitamin C on human bladder T24 cancer cells. In this study, eight commercially available supplements were tested. These included YBG (extract of yeast cell wall), ARBX (arabinoxylan from rice bran), ABE (extract of Agaricus blazei Murill mushroom), ASC (mixed powder of Agaricus blazei Murill mushroom and shark cartilage), MSK (mixed powder of three kinds of mushrooms and three herbs), AHC (mycelial extract of several mushrooms), GD-Fraction of maitake (D) Grifola frondosa mushroom, and PL-Fraction (extract of meshimakobu [Phellinus linteus], which is further discussed below). Six of them showed no effect, but Maitake D and Phellinus linteus did show an inhibition. When nontoxic concentrations of each of these products (30 mcg/ml of beta-glucan from Maitake D and 20 mcg/ml of beta-glucan from Phellinus linteus) were combined with nontoxic concentrations of vitamin C (200 micromoles), there was >90% bladder cancer cell death. None of the other six products showed a synergistic effect with vitamin C.89

Maitake D shows several anticancer effects in animal models, including anticarcinogenesis, inhibition of metastases, and inhibition of cancer growth. It enhances immune function and the effects of a few anticancer chemotherapeutic drugs, while reducing the negative side effects of many of them.90,91 It induces apoptosis and is synergistic with both vitamin C and interferon. It is on the US FDA's list of substances that are generally recognized as safe (GRAS). Maitake D is available from Maitake Products in Japan and the US. The dosage for supplementing cancer patients is 0.5 to 1 mg per kg of body weight per day in divided dosage, 3 to 4 times daily. So, the liquid Maitake D (1 mg per drop) can be given as 25 to 30 drops 3 times daily with 500 mg of vitamin C each time to get the synergistic effect of the two together. It can also be administered as tablets (the 4X form) at a dosage of about 2 tablets 4 times daily for active cancer patients, again along with the vitamin C 500 mg each time. Another fraction of the Maitake mushroom called Maitake SX can be used to help control the metabolic syndrome that predisposes people to cancer. The dosage of Maitake SX is generally 1 to 2 tablets 3 times daily within 30 minutes of completing a meal. It is synergistic with the Maitake D. Crude Maitake at a dosage of about 2 tablets 4 times daily is also synergistic.

Phellinus linteus (Meshima or Women's Island) Extract for Cancer
Another mushroom extract that shows promise as an anticancer supplement is Phellinus linteus (also called Meshima or Women's Island). An article in the British Journal of Cancer in 2008 summarized this extract's antitumor activity: It enhances immune function, induces apoptosis, inhibits proliferation of cancer cells (anchorage dependent growth), inhibits colony formation of cancer cells (anchorage independent growth), and inhibits cancer cells at the S phase of the cell cycle via upregulation of p27.92 In the study mentioned previously by Konno, Phellinus linteus extract was the only product, in addition to Maitake D, that had synergistic in vitro cytotoxic effects with vitamin C on human bladder cancer cells.34 [See Part 2, October 2011.]

Mushroom extracts should certainly be considered for active cancer patients with or without conventional treatment. They also should be beneficial as a preventive for cancer in the first place and also to help prevent recurrences.

This is an expanded version of a lecture presented at the International Society of Integrative Medicine meeting in Tokyo Japan on July 19, 2009. The lecture was partially supported by Maitake Mushrooms Inc. (In the US, the company is now called Mushroom Wisdom Inc.

The full article was originally published in the International Journal of Integrative Medicine July 2010;2(1) and is republished in parts in a slightly modified form with permission.

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